Clinical and surgical assistance in prostate cancer during the COVID-19 Pandemic: Implementation of assistance protocols

Purpose: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. Material and Methods: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. Results: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. Conclusions: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged

Multidisciplinary Experience In The Selection Of Patients For Tubal Sterilization.

Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.113171572

Imbalance of naive and memory T lymphocytes with sustained high cellular activation during the first year of life from uninfected children born to HIV-1-infected mothers on HAART

The immune consequences of in utero HIV exposure to uninfected children whose mothers were submitted to highly active antiretroviral therapy (HAART) during gestation are not well defined. We evaluated 45 HIV-exposed uninfected (ENI) neonates and 45 healthy unexposed control (CT) neonates. All HIV-infected mothers received HAART during pregnancy, and the viral load at delivery was <50 copies/mL for 56.8%. Twenty-three ENI neonates were further evaluated after 12 months and compared to 23 unexposed healthy age-matched infants. Immunophenotyping was performed by flow cytometry in cord and peripheral blood. Cord blood lymphocyte numbers did not differ between groups. However, ENI neonates had a lower percentage of naive T cells than CT neonates (CD4+, 76.6 vs 83.1%, P < 0.001; CD8+, 70.9 vs 79.6%, P = 0.003) and higher percentages of central memory T cells than CT neonates (CD4+, 13.9 vs 8.7%, P < 0.001; CD8+, 8.6 vs 4.8%, P = 0.001). CD38 mean fluorescence intensity of T cells was higher in ENI neonates (CD4+, 62.2 vs 52.1, P = 0.007; CD8+, 47.7 vs 35.3, P < 0.001). At 12 months, ENI infants still had higher mean fluorescence intensity of CD38 on T cells (CD4+, 34.2 vs 23.3, P < 0.001; CD8+, 26.8 vs 19.4, P = 0.035). Despite effective maternal virologic control at delivery, HIV-exposed uninfected children were born with lower levels of naive T cells. Immune activation was present at birth and remained until at least 12 months of age, suggesting that in utero exposure to HIV causes subtle immune abnormalities.FAPESPCoordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES

Comportamento social de ovinos: apresentação de técnicas

The&nbsp; social behavior is a set of activities and relations that develop between peers in certain animal species through a system of communication. Studies in this field began 30 years ago aiming a better understanding of the habits of animals. The main studies on sheep are carried out in Europe; in Brazil there are still few publications related to sheep behavior. Assessment methodologies are based on animal observation for recording activities in the period; therefore, they are simple and do not need many&nbsp;&nbsp; resources. The observations can be made by an observer at the moment of the activity or by recording the actions for later analysis. The most common studies on sheep aim to evaluate ewes at the time of parturition and the immediate postpartum,&nbsp; newborn behavior patterns, the linking of the ewe with her lamb, recognition between sheep and lamb, and the affinity of sheep to man. The most common mistakes that can be committed&nbsp; during an evaluation experiment of social behavior are related to animal handling prior to the experiment, lack of description and assessment of environment, the position of the observer and the genetics of animals. Several methodologies are available and can be modified according to the research aims, and the results help in the management of the environment and natural resources, in the animal welfare, and in the improvement of productivity.O comportamento social &eacute; o conjunto de atividades e de rela&ccedil;&otilde;es&nbsp; que se desenvolvem entre cong&ecirc;neres em certas esp&eacute;cies animais gra&ccedil;as a um sistema de comunica&ccedil;&atilde;o. Estudos nessa &aacute;rea iniciaram h&aacute; 30 anos com objetivo de melhor compreens&atilde;o dos h&aacute;bitos dos animais. Os principais trabalhos desenvolvidos com ovinos s&atilde;o realizados na Europa, e no Brasil ainda h&aacute; poucas publica&ccedil;&otilde;es relacionadas ao comportamento de ovinos. As metodologias de avalia&ccedil;&atilde;o baseiam-se na observa&ccedil;&atilde;o dos animais para registro das atividades desenvolvidas no per&iacute;odo, portanto, s&atilde;o simples e n&atilde;o necessitam de muitos recursos. As observa&ccedil;&otilde;es podem ser feitas por um observador no momento da atividade ou por meio de grava&ccedil;&atilde;o das a&ccedil;&otilde;es para posterior an&aacute;lise. Os estudos mais comuns realizados com ovinos visam avaliar as ovelhas no momento do parto e no p&oacute;s-parto imediato, o comportamento do neonato, a liga&ccedil;&atilde;o da ovelha com seu cordeiro, o reconhecimento entre ovelha e cordeiro e a afinidade dos ovinos pelo homem. Os erros mais comuns que podem ser cometidos durante um&nbsp; experimento de avalia&ccedil;&atilde;o de comportamento social s&atilde;o relacionados ao manejo animal pr&eacute;vio ao experimento, n&atilde;o&nbsp; descri&ccedil;&atilde;o e avalia&ccedil;&atilde;o do ambiente, a postura do observador e a gen&eacute;tica dos animais. Diversas metodologias est&atilde;o dispon&iacute;veis e podem ser modificadas conforme o objetivo da pesquisa, e os&nbsp; resultados auxiliam no manejo do ambiente e dos recursos naturais, do bem-estar animal e auxiliam a melhoria da&nbsp; produtividade

Validity of numerical trajectories in the synchronization transition of complex systems

We investigate the relationship between the loss of synchronization and the onset of shadowing breakdown {\it via} unstable dimension variability in complex systems. In the neighborhood of the critical transition to strongly non-hyperbolic behavior, the system undergoes on-off intermittency with respect to the synchronization state. There are potentially severe consequences of these facts on the validity of the computer-generated trajectories obtained from dynamical systems whose synchronization manifolds share the same non-hyperbolic properties.Comment: 4 pages, 4 figure

Experimental feasibility of measuring the gravitational redshift of light using dispersion in optical fibers

This paper describes a new class of experiments that use dispersion in optical fibers to convert the gravitational frequency shift of light into a measurable phase shift or time delay. Two conceptual models are explored. In the first model, long counter-propagating pulses are used in a vertical fiber optic Sagnac interferometer. The second model uses optical solitons in vertically separated fiber optic storage rings. We discuss the feasibility of using such an instrument to make a high precision measurement of the gravitational frequency shift of light.Comment: 11 pages, 12 figure

Analytical results for coupled map lattices with long-range interactions

We obtain exact analytical results for lattices of maps with couplings that decay with distance as $r^{-\alpha}$. We analyze the effect of the coupling range on the system dynamics through the Lyapunov spectrum. For lattices whose elements are piecewise linear maps, we get an algebraic expression for the Lyapunov spectrum. When the local dynamics is given by a nonlinear map, the Lyapunov spectrum for a completely synchronized state is analytically obtained. The critical lines characterizing the synchronization transition are determined from the expression for the largest transversal Lyapunov exponent. In particular, it is shown that in the thermodynamical limit, such transition is only possible for sufficiently long-range interactions, namely, for $\alpha\le alpha_c<d$, where $d$ is the lattice dimension.Comment: 4 pages, 2 figures, corrections included. Phys. Rev. E 68, 045202(R) (2003); correction in pres

A taxonomy of threat and soothing influences in rheumatic and musculoskeletal diseases and central sensitivity syndromes

Background An imbalance in affect regulation, reflected by a hyperactive threat system and hypoactive soothing system, may impact physical symptoms in people with rheumatic and musculoskeletal diseases (RMD) and central sensitivity syndromes (CSS), including chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome. This study aimed to identify and structure comprehensive overviews of threat and soothing influences that may worsen or alleviate physical symptoms in people with RMD or CSS. Method A concept mapping procedure was used. An online open-question survey (N = 686, 641 [93.4%] women) yielded comprehensive sets of 40 threats and 40 soothers that were individually sorted by people with RMD or CSS (N = 115, 112 [97.4%] women). Results Hierarchical cluster analyses generated eight threat clusters: environmental stimuli, physical symptoms, food and drugs, inactivity, demands, effort, invalidation, and emotional stress. Ten soother clusters were identified: social emotional support, rest and balance, pleasant surroundings, illness understanding, positive mindset and autonomy, spirituality, leisure activity, wellness, treatment and care, and nutrition and treats. Conclusions Our study provided a comprehensive taxonomy of threats and soothers in people with RMD or CSS. The results can be used in experimental research to label threat and soothing stimuli and in clinical practice to screen and monitor relevant treatment targets

The EU societal awareness of landscape indicator: a review of its meaning, utility and performance across different scales

There is increasing recognition that agricultural landscapes meet multiple societal needs and demands beyond provision of economic and environmental goods and services. Accordingly, there have been significant calls for the inclusion of societal, amenity and cultural values in agri-environmental landscape indicators to assist policy makers in monitoring the wider impacts of land-based policies. However, capturing the amenity and cultural values that rural agrarian areas provide, by use of such indicators, presents significant challenges. The EU social awareness of landscape indicator represents a new class of generalized social indicator using a top-down methodology to capture the social dimensions of landscape without reference to the specific structural and cultural characteristics of individual landscapes. This paper reviews this indicator in the context of existing agri-environmental indicators and their differing design concepts. Using a stakeholder consultation approach in five case study regions, the potential and limitations of the indicator are evaluated, with a particular focus on its perceived meaning, utility and performance in the context of different user groups and at different geographical scales. This analysis supplements previous EU-wide assessments, through regional scale assessment of the limitations and potentialities of the indicator and the need for further data collection. The evaluation finds that the perceived meaning of the indicator does not vary with scale, but in common with all mapped indicators, the usefulness of the indicator, to different user groups, does change with scale of presentation. This indicator is viewed as most useful when presented at the scale of governance at which end users operate. The relevance of the different sub-components of the indicator are also found to vary across regions

An Integrated TCGA Pan-Cancer Clinical Data Resource to Drive High-Quality Survival Outcome Analytics

For a decade, The Cancer Genome Atlas (TCGA) program collected clinicopathologic annotation data along with multi-platform molecular profiles of more than 11,000 human tumors across 33 different cancer types. TCGA clinical data contain key features representing the democratized nature of the data collection process. To ensure proper use of this large clinical dataset associated with genomic features, we developed a standardized dataset named the TCGA Pan-Cancer Clinical Data Resource (TCGA-CDR), which includes four major clinical outcome endpoints. In addition to detailing major challenges and statistical limitations encountered during the effort of integrating the acquired clinical data, we present a summary that includes endpoint usage recommendations for each cancer type. These TCGA-CDR findings appear to be consistent with cancer genomics studies independent of the TCGA effort and provide opportunities for investigating cancer biology using clinical correlates at an unprecedented scale. Analysis of clinicopathologic annotations for over 11,000 cancer patients in the TCGA program leads to the generation of TCGA Clinical Data Resource, which provides recommendations of clinical outcome endpoint usage for 33 cancer types